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A Manager’s Response to Workplace Suicide

There are more than 41,000 suicide deaths per year in the U.S; the majority occur among people of working age. This number alone can dramatically affect the workplace. Add to this number that there are about six people affected, many being coworkers, for every suicide death, and the potential impact to the workplace quickly becomes evident.

Even workplaces with the most comprehensive suicide prevention policies and programs are not immune from a suicide that occurs at work or off-site. Because of the high likelihood that at some point a workplace will experience an employee suicide (or a suicide by a client, vendor or employee family member), it is critical that managers know how to respond and facilitate appropriate “postvention” services designed to help employees and the organization recover and return to normal. Postvention services include psychological first aid, crisis intervention and other support services that managers can facilitate for employees following a workplace suicide or suicide attempt.

In 2013, the Workplace Postvention Task Force of the American Association of Suicidology and the Workplace Task Force of the National Action Alliance for Suicide Prevention, in partnership with the Carson J Spencer Foundation and Crisis Care Network, wrote, “A Manager’s Guide to Suicide in the Workplace: 10 Action Steps for Dealing with the Aftermath of a Suicide.” The guide has been evaluated by managers in diverse work organizations, including by leaders in human resources, management, safety, occupational health and wellness and employee assistance programs. The overwhelming feedback about the guide was that it is useful; workplace leaders who reviewed the guide but have not yet experienced a workplace suicide plan to keep the guide as a resource.

As the title of the guide implies, it provides managers with 10 specific actions they can take following a workplace suicide. The actions are divided into phases to help the manager work through the acute phase, recovery phase and reconstructing phase. Additional useful tools for managers include how to draft notification memos and prepare external announcements to disseminate to the broader workplace and the media. Some of the most useful tools in the guide include checklists for how to implement each action, descriptions of how to identify roles for managers during the response, instructions for following crisis decision-making flowcharts and templates for drafting crisis communication messages. The overwhelming majority of users said they would recommend this resource to other managers.

This blog is designed to encourage you to look at the guide and consider using it as a resource, should the need arise in your workplace. We also welcome your feedback on suggestions to make the guide more useful to all workplace leaders. Feedback can be sent to the senior program director at the Carson J Spencer Foundation, jess@carsonjspencer.org. With so many working-aged adults dying by suicide each year, managers need to be prepared to deal with such a crisis. This guide provides concrete steps managers can follow after a suicide to psychologically support their workforce and provide leadership to the work organization as they work to return quickly to normal operations.

Why Employers Must Help Stop Suicide

The American Association of Suicidology said it best when it created this logo for the association: “Suicide prevention is everyone’s business.” By everyone, the association includes employers and work organizations. Considering that the workplace is where the majority of working-age adults spend a significant portion of their day, and sometimes night, it only makes sense that employers and coworkers join the national fight against suicide.

Over the past 10 years, work organizations have begun to realize that they can help identify and treat working adults suffering from depression — a leading risk factor for suicide and also the leading cause of lost work productivity. Despite the knowledge that depression is highly correlated with suicide risk, workplaces have been slow to embrace their potentially critical role in preventing suicide through workplace-based programs. Many of the programs already being offered by employers address depression and can be easily and often freely expanded to also include elements of suicide prevention. The connection between depression and suicide is clear, and employers, large and small, have an important role to take in addressing the public health problem of suicide in our country.

Detecting and treating depression among employees is one way employers can play a significant role. In fact, many employers are already making inroads in minimizing the negative effects of depression and related mental health issues through employer-sponsored benefits such as employee assistance programs (EAPs), workplace wellness programs and occupational health services.

Some of the more commonly offered employer-sponsored interventions at the workplace to identify and respond to depression include workplace-based public awareness campaigns that involve posting suicide warning signs, referral resources and general anti-stigma messages, workplace-based depression screening, such as the program offered through Screening for Mental Health and other early interventions that can be cost-effectively offered through EAP counseling, wellness programs and related occupational health programs.

Improving the detection and treatment of depression and therefore preventing suicide will have a positive impact on the employee and, in the process, the business success of the company. By expanding existing workplace-based wellness programs that often focus heavily on identification and treatment of depression among employees, employers are able to increase the number of employees seeking and obtaining treatment — depression often has low rates of treatment because it is not accurately identified. In fact, prior research shows that, at any given time, depression affects between one-tenth and one-fifth of U.S. employees (Kessler et al., 2008). For employers, this means that for every 100 employees, depression costs employers about $62,000 annually. The majority of this cost does not come from treatment (treatment only accounts for about $9,000), but, rather, costs related to lost work time resulting from sick day absence, work disability (short term and long term disability days) and “presenteeism” (underperformance at the workplace because of illness). In addition, depression and suicide contribute to hidden costs to employers such as lowered morale, increased stress and lower employee engagement and loyalty. The effect of a suicide on coworkers can also be devastating.

In addition to treatment of depression, employers who work with their EAPs and other wellness programs to identify and respond to depression will improve other chronic health conditions. This is because employees who suffer from depression also suffer from an average of 5.1 other chronic health conditions that can complicate treatment and increase costs to the workplace. For example, some of the most serious comorbid conditions in terms of lost productivity with depression include anxiety (48% of employees with depression also have anxiety); chronic fatigue (46%), obesity (29%), chronic sleeping problems (26%) and chronic back and neck pain (32%). (The statistics are from data collected by Integrated Benefits Institute, a leading research organization in health and productivity. See www.ibiweb.org for more information.)

Research suggests that medication and psychotherapy are effective in 70% to 80% of depression cases (RAND, 2008). Employers can require their EAPs and other workplace wellness programs to screen all employees for depression using free and simple validated tools such as the 9-item Patient Health Questionnaire (PHQ-9), where the ninth question asks specifically about suicide risk. Employers can also provide comprehensive depression care management programs for employees screened or otherwise identified to have serious depressive symptoms or for those at increased risk, such as employees who recently went out of the workplace on short-term disability (Desiron, de Rijk, Van Hoof, & Donceel, 2011; Lerner, Rodday, Cohen, & Rogers, 2013; Lo Sasso, Rost, & Beck, 2006).

EAPs are one way through which workplaces have historically and effectively provided help to employees with depression and other mental health and personal problems. EAPs have been shown to be effective in reducing depressive symptoms among employees, including thoughts about suicide (University of Michigan Depression Center). EAPs can provide identification and screening services, such as on-site employee depression screening; however, EAP services go well beyond simple screening and identification. Depending on the services purchased by the employer, EAPs can provide comprehensive assessment, short-term counseling and referral and case management services for longer-term help in the community. Additionally, well-positioned EAPs, those with more on-site access and easy access to consultation with workplace managers and leaders, help to ensure that EAPs are even more effective at recognizing and responding quickly to employee problems such as suicide risk.

Additionally, strategically positioned programs can offer responses that are integrated and in line with the culture of the broader work organization to better serve employees while also supporting workplace productivity. Highly visible and management-supported EAPs can help to reduce stigma toward mental health problems, which in turn will encourage employees to seek help at an earlier stage of their problems and be more responsive to early intervention.

It is important that all employees in the workplace take suicide risk seriously. They should be trained to identify depression and suicide risk among coworkers, not be afraid to ask questions about the well-being of coworkers and refer them to EAPs or other resources when needed. Some examples of companies working to train employees (a designated employee, group of employees or all employees) and raise awareness of suicide and mental health in general are: Chesapeake Energy, DuPont and Johnson & Johnson (see Partnership for Workplace Mental Health for these and other examples).

EAPs can work with employers to develop appropriate training material to help reduce the stigma of mental health problems, not limited to just depression and suicide, so that everyone is able to play a role in contributing to the well-being of the workplace. Just as employees understand and can identify physical safety risks such as falling hazards and safe lifting practices, employees should also understand what to look for when employees may be at risk for a mental health problem.

Even employers who are not able to provide comprehensive services such as EAPs and workplace wellness programs can take small steps that can have a huge impact on saving lives.

One simple first step employers can take to increase awareness of depression and suicide at the workplace is to promote the phone number for the National Suicide Prevention Lifeline (1-800-273-8255) at different locations throughout the workplace where employees will readily see signs, posters and online messages. The Lifeline is a free hotline that can be utilized by anyone who might want to talk with a professional about mental health issues and well-being. Promoting the Lifeline is free to the employer and can be a good way to demonstrate the employer’s interest in the mental wellness of employees. Utilizing free hotline services such as Lifeline is especially important for employees who don’t have access to EAP or other workplace wellness programs.

Overall, we know that workplaces that offer more control to their employees with regard to working conditions that can lower workplace stress, do better with regard to workplace productivity and depression. Therefore, it is critical that employers step up the plate and review and revise workplace policies and programs that are designed to support employees who may be suffering from depression and therefore have increased risk for suicide. By expanding existing programs to include assessment and treatment for depression, employers are working to improve productivity while also preventing suicide at the same time. It is a win-win for employers, employees and society as a whole.

This article was written by Dr. Jacobson Frey; Kimberly Jinnett, PhD; and Jungyai Ko, MSSA.

Usage-Based Pricing: Reality or Fantasy?

In the world of usage-based insurance (UBI), Progressive is an exception: Its massive amount of driving data – 110 terabytes covering some two million vehicles, 1.5 billion separate trips and more than 10 billion miles driven – allows it to quickly test new rating factors and to do so with a great degree of accuracy.

“We continue to test new ideas all the time,” says David Pratt, Progressive’s general manager of usage-based insurance. “Our research team will come up with a theory for what would predict safe driving. With our big data set, we can test those quickly.”

Few other UBI providers are as fortunate. Octo Telematics, which launched its first UBI product in 2002, also has tons of data: 194 billion kilometers of driving performance from two million drivers globally. But most other companies are making educated guesses based on more limited data combined with more traditional ratings factors.

As Nino Tarantino, CEO of Octo Telematics North America, says, “Today, there is no data standard and no clear understanding of which data and how much is required.”

For example, Octo works with seven insurers in the U.S. and Canada, and each one asks for a different data set to be collected – everything from hard braking and acceleration to how many trips a driver takes and how long the trips are, as well as when and where they occur.

Actuarial guidelines often cite 100,000 earned car years as the threshold for credibility for a model, says Dwight Hakim, vice president of telematics, Verisk Insurance Solutions, a provider of underwriting data and tools for UBI. An earned car year is equivalent to one car insured for one year.

In traditional motor vehicle insurance, the number of earned car years is used to show state regulators that an insurer’s pricing decision is based on plenty of evidence. This helps reassure regulators, and helps agents selling the insurance.

“Credibility is particularly important when insurers are constructing a rate plan that might increase premiums,” Hakim says. “Regulators need to see a model with high credibility if that model might result in rate increases. Assuming the insurer has a good financial position overall, modest rate decreases are easier to justify.”

While using earned car years – or the equivalent in telematics driving data – may be critical when an insurer asks regulators to approve a price increase, it may not be strictly necessary to see how different UBI rating characteristics perform, Hakim says.

Trial first, price later

That is what many insurers in need of beginning to test or launch UBI programs are betting on, to avoid the need for a large data set.

For starters, insurers can assume that good drivers self-select for UBI programs. “Chances are [that] the people who try it are more likely to be safe drivers,” says Thomas Hallauer, research and marketing director for telematics consultancy Ptolemus Consulting Group. “So you know you can offer some kind of discount anyway. You also know they will probably stick longer to your contract.”

Another strategy, Hallauer says, is for UBI insurers to collect an initial data set through trials, and to then revise their ratings as more data comes in. Coming up on one full year of offering UBI in the U.S., American Family Insurance used just this approach.

“We feel like we got enough to launch, but as we see the data we know we need to refine it,” says Pete Frey, personal lines UBI program and product manager, American Family Insurance.

Combining telematics data with traditional rating factors, such as age and location of residence, is yet another strategy. The Hartford is one of many U.S. insurance companies to do just that, saying it makes for finer segmentation for its consumers.

“Almost all programs in the U.S. augment telematics data with other carrier-specific rating factors,” Hakim says. “Assessing the degree of overlap among rating factors to avoid double-counting takes a significant amount of work, but carriers are implementing telematics because they know doing so will help them stay competitive and win market share.”

But the benefit of adding more data must equal the cost, Progressive’s Pratt warns. While he agrees that UBI rating will continue to evolve and become more sophisticated, “if it costs a lot to get the information, it’s maybe not worth it,” he says.

Consumer acceptance is another sticking point. “Everything we use has to be something the customer thinks is fine,” Pratt says. “We have to be able to explain to people why it makes sense, why it’s actually fair that we do it that way.”

Pooled data

Finally, insurers can get larger data sets from third-party telematics data providers, such as Verisk Insurance Solutions, Towers Watson and Octo Telematics.

Verisk offers what it calls “Driving Behavior Database for Modelers,” which makes available to statistical modeling applications: data from telematics devices; exposure, premium and loss information on insured drivers; and third-party data, including weather conditions, road type and traffic flow.

Towers Watson has a pooled data offering that collects telematics data and claims, policy, vehicle and driver information. And it uses this pooled data to score drivers and to provide those scores to insurers. Also available from Towers Watson are models that take into consideration third-party information like maps and weather, road type, population density, weather and angle of the sun.

Octo’s Insight Centre collects global, real-time data from its installed base of Clearbox telematics devices, which customers can then interrogate to inform their UBI offerings.

However, there are caveats when it comes to using pooled data.

Hakim, for example, warns that while amassing large quantities of data is critical, not all data is equally valuable. Its utility depends on its accuracy and completeness; how frequently it’s sampled; and the source – whether OBD2 outputs, GPS or accelerometers in cell phones.

“Knowing how each device works and the manner in which the different technologies interact is key,” he says. “The complexities of reading the car’s diagnostic information, appending accelerometer data and then transmitting [it] wirelessly require a deep bench of experience.”

American Family Insurance’s Frey makes a similar point. The availability of aggregated, third-party data is not the issue, he says. While there are plenty of companies offering data to insurers, “carriers are just trying to figure out how to use it,” he says. “The data is almost overwhelming.”

The profit question

One of the big, unanswered questions about usage-based insurance is whether insurance carriers will ultimately be more profitable than – or even as profitable as – providers of traditional motor vehicle insurance.

“It’s an accepted thing that putting in a UBI program for starters is a cost,” according to Frey, of American Family Insurance. “It is about a longer-term strategy. Ideally, companies hope to achieve more growth.”

Among those costs that must be taken into account are the cost of telematics hardware – if an insurer is going the route of using its own devices – and the cost of the back-end infrastructure. Adding UBI on top of an already-existing infrastructure, as major insurers must do, is extremely costly, according to Hallauer, at Ptolemus. In this respect, UBI upstarts that rely on scalable cloud solutions have an advantage, Hallauer adds.

Still, the hope is UBI will ultimately pay off.

Enabling more sophisticated pricing is one benefit. “You want to make sure you have the right rates for the right drivers,” Frey says. “One of the biggest goals is trying to create fair rates eventually.”

And insurance discounts are only part of the equation, Hallauer adds. “The pricing decision is not a discount decision; it’s how do you change the offering to make it enticing?” he says.

According to Hallauer, discount-based UBI incentives will eventually evolve into a more service-oriented approach that may range from life-saving services, such as calling an ambulance after a crash, to more prosaic ones, such as allowing drivers to get a driving score.

Ultimately, he says, UBI can make the customer feel comfortable in having a stronger link with the insurer.

Value beyond discounts

Frey says American Family Insurance is looking in this direction. While it hasn’t pinpointed what services it might offer, it’s considering safety services, making drivers aware of their driving habits and stolen vehicle recovery.

Octo’s Nino Tarantino notes that the value-added services approach is more common in Europe, where some insurance companies offer personal safety and security services, instead of discounts.

The environment is different in North America, he says, because of Progressive. The early mover’s decision to base its UBI offering on a good-driver discount established the tone for consumer expectations and shaped the market.

According to Pratt, at Progressive, the company tries to set its prices so the profit margin is the same for people who sign up for Snapshot, its UBI product, as it is for people who opt for traditional insurance.

Progressive’s theory is that UBI customers will stay with the company longer – and so far that’s been the case. Therefore, the lifetime revenue per customer should be higher, even though the margin is the same as for traditional insurance customers.

Progressive may also save some money through helping people drive better. The company noticed that the driving of UBI customers improved when, a couple of years ago, it added the option of turning on audio feedback in the device so that, for example, it beeps when someone brakes hard.

“We see this training effect within the first few weeks people have the device plugged in,” Pratt says. “They learn to avoid hard braking, and we have evidence it helps people avoid accidents. That could be a big change in the industry, trying to actually reduce your risk.”

But the big win is likely in the life of the customer relationship. Pratt adds. “We are not trying to make ourselves more profitable with this. We are trying to attract and keep good customers for a long time.”

In fact, Tarantino thinks that most usage-based insurance programs cannot succeed if they’re based only on discounts because of all the additional costs associated with them. He says Octo’s experience with 2.4 million insured drivers in Europe shows that “when the benefits of pricing and determining risk are combined with the benefits of the understanding the moment of loss for the insurance company – when there is a crash, that is – it will be successful.”

There is never enough data

So is there any such thing as enough data?

Pratt doesn’t think so. Progressive’s Snapshot considers mileage, time of day and hard braking. The company recently began a pilot using GPS-enabled devices to examine whether highway versus city street driving can contribute to predicting future losses.

Progressive has found that the measurement of how someone drives is indeed a better predictor of risk than driving record, age, gender or any of the traditional rating factors. Still, “the models can still get a lot better,” Pratt says.

Say Progressive wants to find out if people who are low-mileage drivers are safer drivers. The company can segment out those drivers from its customer base and see which ultimately did have accidents and which didn’t. It could go further and segment the low-mileage drivers by age to determine whether low mileage is a good predictor for all age groups.

Even with 10 billion miles driven, there may not always be enough drivers in the database to provide a meaningful segment to test a theory, Pratt says.

 

This article has been produced in the lead-up to the Insurance Telematics USA conference and exhibition, which will take place in Chicago on Sept. 3-4. This conference will tackle the steps needed to take UBI programs to the mass market. Find out more here.